The challenges in PPIUD provision are not limited to maternity services, as there are also difficulties in agreeing and funding follow-up pathways for thread checks and ultrasound. In some areas, these postpartum checks are provided in primary care, whereas in others they take place in local sexual health clinics or hospital settings. Lack of clarity and ease around PPIUD follow- up pathways has been highlighted as an area for improvement. Like other parts of the UK, we have observed that while there is no shortage of enthusiasm to implement these services, it has been difficult to sustain comprehensive PPC provision over time in the face of staff rotations and shortages, lack of investment in services and competing clinical priorities. It continues to rely on a small number of highly motivated healthcare professionals to maintain momentum, which it itself is also often unsustainable. However, the need to improve access to PPC in Scotland is no less than when this work first began. Indeed, more recent data suggests that the rates of short inter-pregnancy intervals may be higher than originally thought in many parts of the country. One of the ongoing challenges around identifying gaps in regional provision relates to routine data collection processes. At present, PPC performance activity is not nationally coded or reported, and existing electronic maternity data collection systems are not designed to capture this activity reliably. As such there is a need for national systems-based improvements, which is a key area of ongoing work for the Scottish PPC Network.
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